Nutrition, supplements, and exercise

Transcription

1 Nutrition, supplements, and exercise Walter R. Frontera, MD, PhD Professor and Chair Department of Physical Medicine and Rehabilitation Vanderbilt University School of Medicine And Medical Director of Rehabilitation Services Vanderbilt University Medical Center

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4 Loma Linda, California Sardinia, Italy Icaria, Greece Okinawa, Japan Nicoya, Costa Rica

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6 Resistance exercise (2 weeks) and muscle protein (MHC) synthesis v. lateralis fract. synth. rate (%/hr) pre # post * * young (23-32 yr men & women) old (78-84 yr. men & women) * = pre vs. post; # = young vs. old; from: Hasten et al. AJP 278:E620, 2000

7 Some anabolic strategies Diet Protein intake Hormones Anabolic steroids Testosterone Human growth hormone

8 Diet high intake of amino acids leucine (>2g; milk products) high levels of total protein (25-30 g) coupling with exercise

9 Forest plot of the results of a random-effects meta-analysis shown as pooled mean differences with 95% CI on 1-repetition maximum leg press in both younger and older subjects (weighted mean difference: 13.5 kg; 95% CI: 6.4, 20.7 kg; P < 0.001). Cermak N M et al. Am J Clin Nutr 2012;96: by American Society for Nutrition

10 Figure 4. The response of skeletal muscle protein synthesis to resistance exercise without nutrition (RE Only) (11) and resistance exercise followed by essential amino acid (RE + EAA) ingestion 1 h after exercise (9) in young and older adults. Aging is associated with an impaired skeletal muscle protein synthesis response to RE only; however, this impairment is overcome with postexercise nutrient ingesting. Furthermore, nutrient ingestion after resistance exercise produces an additive increase in skeletal muscle protein synthesis in both young and older adults. *Different from basal in respective study, P #Different from older in respective study, P < Exercise and Nutrition to Target Protein Synthesis Impairments in Aging Skeletal Muscle. Dickinson, Jared; Volpi, Elena; Rasmussen, Blake. Exercise & Sport Sciences Reviews. 41(4): , October 2013.

11 Ingestion of diets with an EVEN (30g tid) or SKEW (10, 15, 65 g) protein distribution (Mamerow et al., J Nutr. 2014;144:876) 24 h mixed muscle FSR (%/h) Day 1 Day # * * Even Skew * = different from EVEN at that same point, P<0.05; # = main effect of group between EVEN and SKEW; not combined with exercise training

12 Marcotte et al., CTI 96:196, 2015)

13 Effect of vitamin and protein on muscle (RCT) Daily protein intakes should be 1 to 1.2 g/kg BW/day (1.2 to 1.5 with acute and chronic disease) Tested the hypothesis that a supplement containing whey protein(20 g) enriched with leucine (3 g) and vitamin D (800 IU) (vs. an iso-caloric supplement) taken before breakfast and lunch would stimulate muscle protein synthesis 13 week multicenter (6 countries in Europe) RCT among non-malnourished elderly (380 randomized), independently living with mobility limitations Outcomes included short physical performance battery (SPPB primary), handgrip muscle strength (primary), muscle mass, self-reported physical activity, independence in ADL s, health-related quality of life, dietary intake records Bauer et al. JAMDA 1-8; 2015

14 Primary and secondary outcomes Supplement group achieved an intake of 1.5 g kg BW per day Significant differences between groups in chair stand ability and muscle mass No significant differences in SPPB, independence in ADL s, quality of life

15 Vitamin D, strength, and mobility (TUG): a meta-analysis Rosendahl et al., JHND by American Society for Nutrition

16 Some anabolic strategies Diet Protein intake Hormones Anabolic steroids Testosterone Human growth hormone

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18 Anabolic steroids (Mavros et al., MSSE 47: 2257, 2015)

19 Anabolic steroids(mavros et al., MSSE 47: 2257, 2015)

20 % change in mid-thigh csa Strength training and testosterone in frail elderly males (Sullivan et al. MSSE 37:1664, 2005) 71 hypogonadal men (78.2 years) 10 Four groups: resistance (20% or 80% 1RM) and drug injections (placebo or testosterone) 8 6 P=0.006 P= No significant interaction between strength training and testosterone 2 No effect on functional performance 0 P T LR HR Drug effect Exercise effect

21 Growth Hormone (GH) alone or combined with resistance exercise in healthy elderly men (Lange et al. JCEM 87: , 2002) 31 healthy men (74+1 yr) 3/wk; 3-5 sets of 8-12 RM reps Four groups (RT+placebo; RT+GH; GH; placebo) GH = increase 2X myosin Change in quads CSA (%) * * High incidence of side effects (12 of 15 receiving GH pitting edema, CTS, weight gain, A. Fib, trigger finger 3 0 RT+placebo RT+GH GH * = different from baseline; no difference between RT+placebo and RT+GH (p=0.16)

22 Supplements for the prevention or treatment of nutrient deficiency (do not enhance muscle function) Calcium Iron Multivitamin Vitamin D ACSM and ANDDC MSSE 2016

23 Supplements that enhance performance Beta-alanine (acid-base) Caffeine (fatigue) Creatine (energetic pathways) Nitrate (vascular effects) Sodium bicarbonate (acid-base) ACSM and ANDDC MSSE 2016

24 International Society of Sports Nutrition position stand: creatine supplementation and exercise Creatine monohydrate is the most effective ergogenic nutritional supplement currently available to athletes in terms of increasing high-intensity exercise capacity and lean body mass during training. There is no scientific evidence that the shortor long- term use of creatine monohydrate has any detrimental effects on otherwise healthy individuals. The quickest method of increasing muscle creatine stores appears to be to consume ~0.3 grams/kg/day of creatine monohydrate for at least 3 days followed by 3 5 g/ d thereafter to maintain elevated stores.

25 Group mean absolute [PCr] response to heavy-intensity exercise (A) and subsequent recovery (B). (Andrew M. Jones et al. Am J Physiol Regul Integr Comp Physiol 2009;296:R1078). Supplement = open circles

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